Bourdais Julien

Dissertation title: Between public and private: Hospital care of psychiatric patients in the age of outpatient care

Under the supervision of Alain Ehrenberg

My dissertation seeks to clarify, by means of ethnographic and statistical methods, the ambiguity of the place held by private psychiatric clinics in the field of mental health. The goal is to understand how the kind of hospitalization offered in these clinics (care extended for more than 24 hours under medical responsibility) is articulated with all the other forms of care extended for mental disorders, most of them public and above all, very diverse. To do so, I am focusing particularly on the moments of admittance to and release from a private psychiatric clinic: What place does this hospitalization take in the care trajectory of patients? How involved are the various clinical professionals in these moments? How much do clinical institutional partnerships determine how patients are admitted and released?

These questions arise from recent historical and sociological work that has described an intensification of psychiatric-hospital reforms in the 1950s, the establishment of forms of care networked (as “the psychiatric sector”) beyond hospital walls starting in the 1960s, then beginning in the 1990s, the institution of “mental health” policies aimed at integrating medical, medical-social, and social care. The issue shared by these various transformations in the care supply is to ensure continuity of care for persons suffering from mental disorders. Integration of private clinics into these reforms was often only partially thought out and has hardly been studied. The field of mental health has changed in such a way that full-time hospitalization is associated with alternatives. Whereas the public network is organized at the scale of a French département or at a smaller scale, private clinics, which for the most part provide psychiatric hospitalization, are not automatically associated with this network.

At a time when full-time hospitalization should be one option among others in the trajectories of persons suffering from mental disorders, what is the place of institutions specialized in hospitalization and the inclusion of which in a network of care supply is yet to be built? To try to answer this question, I plan to study via an ethnographic approach two very different private clinics as well as to study national statistical data on private for-profit health institutions in the field of psychiatry.